Educational Goals and Objectives of the University of Washington

First Year-Level R-II

Medical Knowledge Objectives:

1. Initial lecture during the summer on Successful Radiology Resident Strategies will include the fundamental approach to the four steps of image interpretation and 2 steps of differential diagnosis. A checklist for each type of Neuroradiology CT and MR examination will be provided as a template for mastery of this discipline.

2. Introduction to CT image interpretation will commence at Harborview Medical Center (HMC) during an initial 4-week rotation. The resident will interpret CT images of the head, spine and face, with an emphasis on trauma and intracranial hemorrhage (including CT angiography).

3. A systematic image interpretation approach based on the checklists (see above) will be reinforced.

4. A second four-week, part time Neuroradiology rotation (Tuesdays & Thursdays) at the Seattle VA Medical Center (VAMC) will follow the Neuroradiology month at HMC. CT imaging emphasizing the head (stroke), sinus, neck, and degenerative spine will reinforce lessons learned earlier.

5. Initial introduction to basic MR interpretation will occur at the VA, with emphasis on brain and spine MRI. Pulse Sequence recognition and utility will be emphasized in addition to reinforcement of a systematic diagnostic approach.

6. The VA rotation will give the Resident an introduction to handling hard copy CT and MR film.

7. The Residents will be directed to pertinent books on Neuroradiology, Head & Neck Imaging, etc.

Second Year-Level R-III

Medical Knowledge and Technical Skills Objectives:

1. Residents will be given at least one 4-week Neuroradiology rotation at the Seattle VAMC, with many also getting a second Neuroradiology rotation on Neuroradiology Procedures at the University of Washington Medical Center (UWMC).

2. At the VAMC, the resident will get more expertise in the interpretation CT and MR of the head, neck, spine and peripheral nerves. More experience with CT angiography and MR angiography will also be gained.

3. Both the VAMC and UWMC Neuroradiology rotations for the second year Radiology Resident will introduce the resident to performing various Neuroradiology procedures, including myelography and cerebral angiography.

4. Residents will be given detailed handouts instructing them on how to perform lumbar, thoracic and/or cervical myelography. Direct supervision of the myelography by the Attending Neuroradiologist will occur from the placement of the spinal needle, injection of intrathecal contrast, and finishing with the filming process. Myelography via umbar punctures will primarily be taught, with the occasional opportunity for C1-2 puncture. Use of the C-arm will be needed for some difficult punctures.

5. The Resident will also be introduced to Neuroangiography at UWMC and occasionally at the VAMC. Responsibilities will include initial patient evaluation and obtaining informed consent for the procedures. The Resident will learn techniques for puncturing the femoral artery, basic use and manipulation of cerebral angiography catheters and guide wires. The Resident will assist in the diagnostic portion of these procedures. If therapeutic intervention is needed or planned the Resident will be able to observe the Neuroradiology Fellow and Neuro-interventional radiologist perform embolizations, ballon angioplasty, etc. Post procedure care and documentation will also be taught.

6. Occasional opportunities for CT guided needle biopsy of the neck and spine will allow the Resident to learn the approach and various techniques of invasive imaging guided needle biopsy.

7. The Residents will be encouraged to continue reading on Neuroradiology topics, as well as reinforcing diagnostic skills utilizing the ACR Teaching File CD library.

Third Year-Level R-IV

Medical Knowledge and Technical Skills Objectives:

1. Residents will usually get a second month of Neuroradiology procedures at Harborview. The high volume of diagnostic Neuroangiography will allow the third year resident to become increasingly proficient in femoral punctures and catheter manipulation. Further experience in myelography will be available.

2. Third year Residents will get an additional month rotation at UWMC in diagnostic CT and MR imaging. The patient population at this tertiary care facility will broaden the Resident’s experience with imaging of neoplasm, infection, inflammation, and degenerative diseases of the brain, head & neck, spine and peripheral nerves. Mastery of the systematic checklist approach to imaging will occur though constant reinforcement.

3. The Resident on the imaging rotation will be encouraged to learn basic 3-D image creation and manipulation on the 3-D workstations.

Fourth Year-Level R-V

Medical Knowledge and Technical Skills Objectives:

1. Neuroradiology rotations will include Neuroradiology procedures and/or CT/MR imaging. Emphasis will be on refining interventional skills (myelography, neuroangiography and biopsy) and broadening the Resident’s experience with a wide variety of diseases of the brain, spine, head & neck, and peripheral nerves using CT and MR.

2. Reinforcement of systematic approach to image interpretation and differential diagnosis will continue in preparation for Radiology board examination. The ACR Neuroradiology and Head & Neck Teaching File CD library will remain a resource for polishing diagnostic skills along with the major textbooks in Neuroradiology.

Name: Yoshimi Anzai, M.D., M.P.H., Section Director.